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Teaching Mindfulness to reduce stress and depression in expectant parents

By Kelly Brusch and Nancy Bardacke

Two photos, one of Kelly and one of Nancy. Both are white women. Kelly has long blond hair and is wearing a blue top. Nancy has short white hair and a grey top.

Pregnancy and birth, under the best of conditions, can be a stressful time for expectant parents – and right now, across the globe, pregnant couples are experiencing previously unimaginable levels of stress, anxiety, isolation, and depression due to the COVID-19 global pandemic. Birth providers are also navigating new challenges and stressors as they consider how to best support families during the transformative time of pregnancy, birth, and early parenting.

According to published research by Dr. Larissa Duncan and Nurse Midwife Nancy Bardacke, stress in pregnancy has been associated with preterm labor, a decrease in the quality of the childbirth experience, and an increase in postpartum depression. It can also lead to a decreased quality of attachment between a mother and her infant, postpartum couple conflict, and less than optimal neurocognitive development of the child.

This is where mindfulness practice comes in. Studies show that mindfulness practice helps us cope more effectively with stress, pain, illness, depression, and anxiety. Evidence also shows improvements in brain and immune function. A two part research study published by Dr Larissa Duncan found that expectant parents who learned mindfulness skills before the baby was born showed lower maternal depression symptoms during pregnancy and immediately following childbirth and lower perceived distress through the first 1-2 years postpartum. 

There have been hundreds of published research articles on how mindfulness can reduce stress and depression, but what exactly is it about mindfulness practice that makes such an impact? And what about when it is applied in childbirth preparation?

What we know about mindfulness is that it is the practice itself that allows us space and time to cultivate new inner skills. The more we formally practise, the more likely it will be that these new skills can be applied right in the present moment in daily life. Here are some life skills that practising mindfulness during pregnancy may cultivate:

  • an acceptance of present moment experiences
  • non-attachment to expectations about the future
  • healthy physiological conditions which promote optimal functioning of the body
  • awareness of inner resources that allow for more “responding” vs. “reacting” to everyday challenges
  • compassion for oneself and others
  • an opportunity to reassess one’s relationship to both physical and emotional pain

Every woman’s labour and birth is unique; however, when we look at birth physiologically, we can see some universal features. When we teach mindfulness skills to prepare for childbirth, expectant parents learn how the inner skills they cultivate during mindfulness practice can help facilitate the normal physiological birth process.

The birth process involves intense physical sensations, which most women call pain. And the pain of childbirth is what midwife Nancy Bardacke, who developed the Mindfulness-Based Childbirth and Parenting (MBCP) program, describes as transformational pain. Transformational pain is normal pain. This pain is not a signal that something is wrong; it is a result of a rapidly changing body that is doing what it is meant to do. As Nancy describes in her book, Mindful Birthing:

“Mindfulness practice helps us connect with the truth of transformational change and perhaps helps us to see childbirth in a new light: it certainly can be comforting to know that however long your labor lasts, it is not a permanent condition. Nothing is.”

What we also know about childbirth is how one’s relationship to fear and pain can inhibit the body’s natural physiological processes. Through mindfulness practice we can become more aware of our relationship to fear and pain and find moments of ease, presence, and even peace during childbirth.

Birth providers across the globe are curious about how to cultivate a mindfulness practice of their own to cope with the stressors of work and life, as well as being interested in learning how to teach mindfulness to expectant parents in the communities they serve. The Mindful Birthing and Parenting Foundation has trained nearly 200 perinatal birth professionals from 28 different countries how to teach Mindfulness-Based Childbirth and Parenting (MBCP) to expectant parents.

One birth professional describes her motivation for training to teach mindfulness skills to expectant parents as:

“To teach mindfulness for expectant parents is to guide them how to “dance in their contraction of life with mindfulness”, to help them to face every pleasant and unpleasant moment mindfully.”

Or as another MBCP teacher puts it,

“The most important value of teaching mindfulness for expectant parents is the opportunity to contribute to a decrease of intergenerational suffering. There can’t be peace in the world until there is peace in our homes.”

To learn more about the benefits of teaching mindfulness skills to expectant parents you can:

………………………………………………………………………………………………………………………………………………………………………………..

Nancy Bardacke, CNM, MA, is the Founding Director of The Mindful Birthing and Parenting Foundation

Kelly Brusch, MA, is the Managing Director of The Mindful Birthing and Parenting Foundation

Becoming a doula during Covid – Sophie Burns’ experience

By Sophie Burns

Photo of Sophie and her fluffy light brown cat.

Sophie has received permission from her clients to share their details in this article.

In February last year I got my first booking from a birth client. This was what I had been waiting for and I was so excited. Coronavirus was being talked about in the media, and on my birthday I went out for lunch with two friends, one of whom had just got back from Singapore. “Buy loo roll” she said. The other friend and I laughed…

[Read more…] about Becoming a doula during Covid – Sophie Burns’ experience

A grandmother’s perspective on stillbirth: For Cillian

By Sharon Bridges

Photograph of Sharon, Sharon's daughter (Cillian's mum) and Sharon's aunt. Sharon's daughter is wearing a blue sash which says 'mum to be'.
Sharon, her daughter and her aunt at Cillian’s baby shower, before they received his diagnosis.

During my mentoring session with Michelle Every, facilitator of Supporting Every Birth, Michelle suggested that I write an article on the experience from a grandparent’s point of view. Around this same time, my daughter bravely made a Vlog offering support and sharing her own experiences, so I felt this was a suitable subject for me, following the loss of my first grandchild, Cillian.

Cillian was a little blessing we were told was on his way on Christmas Day 2019. I had lost my daughter Sophie in 2018, which made Christmas a difficult time, as it was Sophie’s favourite time of year. My older daughter, Hannah, had been planning to start a family in 2018, but following the loss of her sister she decided to wait until we were in a better frame of mind to welcome and nurture a new life, so this news was indeed very special. Hannah was only around the 6 weeks stage, and a bit nervous telling family, as my niece had sadly suffered a miscarriage of her first little girl in November 2019. Sure, what could possibly go wrong, when we had already been through so much loss? The 12 week scan showed everything appeared to be going well, and the 17 week scan confirmed this, but there was a brief mention of a little fluid on the kidneys. The hospital staff were more concerned with adhering to Covid-enforced restrictions to answer the questions of an anxious first-time mother, so Hannah decided to have some private scans carried out. Again, these showed no major cause for concern, and revealed that we were expecting a little boy.  A small heart defect was indicated, along with the fluid in the kidneys, so Hannah was referred to the Foetal Medicine department in the Royal Victoria Hospital, which is really the highest level of care on offer in Northern Ireland. The specialist could still find no reason to worry, and felt that perhaps by delivering early and having a look at the heart, Cillian had a good life ahead of him.

How did that go so wrong? At 32 weeks, Hannah went through an amniocentesis to put her mind at ease before being induced, and at his point we discovered our beautiful little man had Patau’s syndrome, Trisomy 13. None of us had ever heard of this. We were familiar with Down’s syndrome, as I have a cousin who has had a wonderful 45 years of life so far with this condition, and that was the reason I had advised against this invasive procedure. If our worst-case scenario was Down’s syndrome, our grandson would still be so loved and a welcome member of our family. We were not prepared for this news in any way, and it felt like a horrible, cruel trick. We were given this news on a Wednesday, and told Hannah would be induced on the following Saturday. I still believe that where there is life, there is hope, and on those nights I stayed with Hannah before she went into hospital, we made memories with her little bump. We told him how much we loved him and wanted him to be part of our family, although Hannah and her husband Paul did not want to be given any false hope. My heart was completely shattered, but I kept it inside when I was with them, but when I was alone in the middle of the night, that is when the tears came.

Saturday the 27th June 2020 arrived, and Hannah and Paul had to report to the maternity hospital alone. Throughout lockdown, Hannah had to attend all her maternity appointments alone, but there was no way was I letting her face this unsupported. Having been induced 3 times myself, and also working in a maternity hospital, I was aware that we were probably in for an arduous journey of days, rather than the hours they were both expecting. I felt sick all day waiting for news, but it was only when the night staff were on duty that I was allowed to join them at the hospital. It was a horrible stormy night, as if Belfast was offering me her sympathies, but I made my way to the special Snowdrop room, which would be my home for the next few days.

That first night felt like it went on forever, as the niggling cramping of early labour began, but it was evident there was not much progress to be made. I guess that’s when my doula brain kicked in, and I encouraged Hannah and Paul to get some sleep.  The last thing you will feel like doing is eating and drinking, but it is vital that you all keep your strength up and stay hydrated. The staff were amazing, every one of them, who treated us with such compassion and empathy. Sunday was another long day, and between us we decided Paul should go home overnight for a proper rest and meal, while Hannah and I had our last bonding time with little bump, watching silly comedies that reminded us of happier times with Sophie.

Our perfect, precious little Cillian arrived and departed this world on Monday 29th June, born sleeping, still warm when the midwife handed him to me. It was surreal, being handed this beautiful little boy by someone who said ‘I am so sorry for your loss’. I wanted so much to try to resuscitate him, as I ached so much for him to breathe, that I put my mouth over his tiny mouth and nose, just waiting for a sign of life. I longed so much to hear those first little cries, but this was not to be, Sophie had already welcomed her little nephew to her as he entered the world. As Hannah and Paul comforted each other and expressed the rawest of emotions, I held Cillian to my heart and allowed one tear to escape, before reuniting him with his mummy.

The Snowdrop room in the Royal Victoria Hospital had been set up in 2018 by a family who had gone through this life-changing experience, and although it is in a maternity hospital, it is separate from the labour wards and delivery rooms. We had a sacred place to spend as much time with our special little man as we needed. I won’t go into all the sentimental things we did as it was personal to us as a family, but we were so thankful that we had that time with Cillian, and he was treated as a person in his own right by all of the wonderful staff, who not only looked after Hannah, but myself and Paul also.

My reason for sharing this with you is really just to give you a little background on our family dynamic, but I would like to share some suggestions to any grandparent who is facing the same scenario. Yes, you want to scream, and cry, and curse, so do it, when and where appropriate of course! Your child needs you to appear strong and calm, no matter how sick you feel inside. Your child is still, and always will be, your child, so you place your own pain aside and care for them first. Be there. I was told I may not ‘be allowed’ into the hospital, but no force on this earth would have kept me away. Make your memories, before and after the birth. That little heart is still beating, those little ears can still hear you and recognise your voice. Believe me, you will thankful that you did. Acknowledge that tiny life as part of your family. One thing that particularly touched me was a text message from my own mother, saying ‘I am so proud to be his great grandmother, and I love him’.  This also reinforced in me the assurance that your mother is, and always will be, your source of strength, and in her eyes you are forever her child. You may want to consider what you would like to dress the baby in, or put in the cot with them, but the hospital staff were a great help to us as we had not really given this a lot of thought. We picked a little outfit for Cillian, and the staff gave us a beautiful memory box containing 2 little blankets and teddy bears. One set went with Cillian, and the other stays with us. I have a ring that I had made containing Sophie’s ashes, and I placed this in his little hands overnight, so know it has an extra special meaning to me. Take photos, lots of photos. These will be all you will have to look back on, so make the most of every opportunity. It is not as morbid as it sounds, trust me.

Of course, there are practical things that need to be considered, such as registering the birth and death, or receiving a certificate of stillbirth, and arranging a funeral. Again, the hospital staff took care of so much, and we are eternally grateful for their support. There is so much more I could share, as a mother, a grandmother, and now a doula, but we experience every moment in our own way, and our journeys are all unique. Rest assured, you will get through this, your child will get through this, and there will be happier times ahead, but you will always have that little angel tucked away in your heart.

Cillian showed me that my calling was to become a doula, and I intend to offer my services to any woman facing this experience, who may not have family support around her. I will honour his memory, give him this legacy, and breathe the meaning into his existence that I was unable to breathe into his little body, and he will always be my first grandchild.

For Cillian Noel O’Gallachoir, 29th June 2020.

Further information and support:

SOFT UK: A charity providing support and information to parents of children with Trisomy 13 (Patau’s Syndrome), Trisomy 18 (Edwards’ Syndrome) and other genetic differences, before and after birth. https://www.soft.org.uk/

Sands: A charity which supports those who have been affected by stillbirth and neonatal death. https://sands.org.uk/

Miscarriage Association: A charity to support people affected by miscarriage: https://www.miscarriageassociation.org.uk/

Supporting Every Birth: Nurturing Birth’s interactive workshop created for doulas and birth workers looking at supporting both clients and themselves through all birth journeys including baby loss. https://nurturingbirth.co.uk/retreats-and-workshops/supporting-every-birth/

When a baby dies

Photo of Michelle Every, Michelle smiling. She is standing with moorland behind her. her long hair down to her shoulders. She's wearing a teal padded jacket.

By Michelle Every

What do you say when someone – a doula client, a friend, a relative – tells you that they have experienced a miscarriage or stillbirth? Michelle Every offers some support, information and signposts.

When I trained to be a doula in 2007 I was astonished and saddened that supporting baby loss was not mentioned on my course. Then as I gained experience and connected deeper into the doula community I noticed that loss was not something that I saw being discussed. 

In 2014 I felt a strong conviction to change this so I created the Supporting Every Birth workshop. I wanted to create a safe space to explore loss with a focus on self-reflection and group participation and give time to consider where we are with our own grief being curious and honest with ourselves around our own views and opinions on loss

When talking to doulas about baby loss the two phrases I most often hear are “But what will I say?” or “I worry I will say the wrong thing.”

There is fear around the power of language.

What we do or do not say is not just relevant to supporting loss or supporting clients. It is relevant in every exchange we make in our everyday life. How we respond to what we hear can have a significant impact on the person sharing. Have we heard them or are we focusing too much on our own answers or our own story? How can we offer space, actively listen and resist the need to fix?

When I am considering my choice of words I keep the Nurturing Birth values of respect and compassion at the forefront of my mind. These values lay a great foundation when considering language, can shape my conversations and prevent me from saying something in anger or frustration.

Is what I am about to say respectful and compassionate?

Coming back to supporting loss, what do you say to someone who has discovered their baby has died during pregnancy? Or what can you say at a labour when the baby is born not breathing and has died?

I volunteered for the Miscarriage Association for fifteen years. When I answered the phone and listened to people share their own stories of loss I would hear how the countless times their family, colleagues and friends had said unhelpful things such as “Everything happens for a reason” or “Just move on.”

From my experience of facilitating loss support groups I am aware how a spoken phrase can bring much comfort to one person only to upset another. No one way works for all. It is good to remember that grief is a natural, unique and personal response to losing something important to us. As doulas we want to validate this uniqueness while acknowledging the challenge that this can bring to us personally. We are required to offer support in the moment and respond to what we see and hear rather than having a pre-planned and prepared response. 

Maybe we are beginning from the wrong place. Instead of starting at what we will or will not say it might be helpful to start with what can we be. How can we be our most authentic self and respond to the needs of the family we support? 

On the Nurturing Birth doula courses and within mentoring we talk about being rather than doing. Our skills are listening, holding space, being client led, responding to needs in the moment. We go to births with no guarantees or certainty and yet we go with confidence that our presence and commitment to the family will make a significant difference 

Is this any different when the baby does not survive?

We can create the same environment, listen with the same focus and respond in the same way. 

To be honest, and to give a little away from my workshop, not much changes in the support we offer in loss compared to supporting clients with live babies.

We simply doula.

The Miscarriage Association has created some excellent resources which come from supporting loss for many years, including this video -when you do not know what to say, simply say “I am sorry.”

How do you feel about supporting families through baby loss? Do you have concerns on what to say? I would love to welcome you on to the Supporting Every Birth workshop to explore the topic more. My desire is that every doula feels able to step into this role and offer support.

If you would like to talk to me more about the Supporting Every Birth workshop please get in touch – michelle@nurturingbirth.co.uk

Nurturing Birth Book Review: The AIMS Guide to Resolution After Birth

Book review by Natalie Stringer

Image of the book "The AIMS Guide to Resolution After Birth"

The AIMS Guide to Resolution After Birth, by Shane Ridley, is available from the AIMS shop as a printed book or on Kindle, for £8: https://www.aims.org.uk/shop

“An absolute must-have resource.”

This book from the Association for Improvements in the Maternity Services (AIMS) is an absolute must have resource guide. It will point you in the right direction to find answers and peace following a challenging birth where you have experienced traumatic events.

All information provided in this book is completely up to date being published in 2020, therefore all signposting to relevant websites are accurate and still in practice.

There are so many different, confusing avenues you may need to explore when wanting to raise a concern or make a formal complaint after birthing a baby. This book very easily allows you to recognise and guide you towards the best route for your individual circumstance. It is UK specific and highlights the different organisations in England, Scotland, Northern Ireland and Wales, so you can contact the relevant people in your country. There are some time limits when making a formal complaint within the NHS Maternity system, and these are highlighted in the book. Therefore having this guide to hand to dip in and out of when you feel comfortable, will help you piece together what you need in a time frame that suits you, but does not exceed the cut off point.

There are template letters provided in the book that you can work with to raise a concern or make a formal complaint. Numerous support organisations and charities are listed throughout the book, enabling you to seek out who can help guide you through this process, if necessary.

The book also provides a great insight into how to prepare for a subsequent birth and who to liaise with, as this will help ensure certain traumatic events do not reoccur again. Guidance on how to write your ‘birthing decisions’ is a great resource and will give you the foundations to make this birth better and more in-line with your own personal needs. It provides different options for you to choose the best support for you throughout your next pregnancy, labour and birth. This will help ensure you can feel more emotionally and physically in control of your decisions and your autonomy.

Exploring how you feel about your difficult birth experience and/or the care you received is discussed in Chapter 3 of this book. I know this will be so comforting for many mothers and birthing people who decide to put pen to paper and allow their experience to be validated. This may just be a starting point that encourages you to recognise that you do indeed wish to raise a concern or make a complaint. For others it may provide enough emotional release and your resolution may end there.

The language used in the book can be a little difficult to digest in some places. Although written thoroughly and very clearly, some areas can be a little heavy on abbreviations and putting a sentence together in places may need re-reading a few times to help it sink in or understand which organisation or charity has been written about.

Ultimately, many readers will be looking to find much needed answers and therefore it can be used as a reference book. So it may be a case of finding the relevant chapter(s) for their individual needs rather than reading the book from cover to cover. The contents pages at the beginning make it easy to navigate through whilst missing out sections that are not relevant to you. However, I believe every birth worker should read every page of this book and refer to it often, not only to recommend to their clients who need to seek resolution after birth but also to locate relevant information very quickly.

As part of ‘The AIMS Guide To’ series of books I believe this one will help many, many birthing people find their inner strength and courage to explore not only what happened during and following the birth of their babies, but also find the light to indeed seek resolution.

The main success of this book is giving parents the permission to find a way to raise their concerns or make formal complaints about their birth experiences. Together, if more people feel listened to, respected and supported when choosing to revisit their difficult experiences in order to find answers, they will be paving the way for a better maternity system for birthing people now and for the next generation.

Book review writted by Nurturing Birth Doula Natalie Stringer.

Natalie can be found at www.equilibrium-birthing.com or on the Nurturing Birth Directory: https://nurturingbirthdirectory.com/doulas/united-kingdom/kent/sevenoaks/natalie-stringer/

My Journey as a new Doula, through 2020!

By Helena Whitwell

The past year for me, has really seen a new phase of my entry into the Doula world. It has included many moments of uncertainty, self-doubt, huge excitement, and anticipation. It’s amazing to look back on my doula journey and reflect on what has happened!

I absolutely loved my Nurturing Birth doula training, which I completed in 2019. Then began the next phase, where I began to ask questions like ‘When is the right time to start doulaing?’ ‘How do I stop my current job and start doulaing?’ It all felt like a waiting game, with so many things to consider such as my income and the needs of my children.

In March 2020 (eek- doesn’t that month ring alarm bells!!) I had arranged with my employers to reduce my part-time admin job hours and make space in my week to start investing in my doula work. I began using my few extra hours a week to network, start an Instagram account, and find opportunities of local groups to attend. I was daunted, had a lot of self-doubt, and just really wasn’t sure how to get myself known out there! How on earth would I get my first client??

Then of course, that very month, the world changed, schools closed and suddenly I had two children (8 and 5) at home 24/7. This was most definitely not in the business plan!

Fortunately, I was able to maintain my part time job flexibly from home, as well as try and entertain/home school my children. But that’s a whole other story! For the purposes of this blog my dreams of being a doula went back on hold.

PREGNANCY PRAYER

A few friends from my church were pregnant at the start of 2020, and I wanted to do what I could to support them in their pregnancies, help them as they prepared for their births and also encourage them to connect with God too. Before lockdown I hosted an evening for this group to chat, share anxieties, pray for each other and their babies too. They all said they found it really helpful, and wanted to do more of it.

When lockdown began, I decided to try leading them in some reflective prayer sessions over Zoom! Initially this was for a couple of friends, just before their births. I got them to prepare a comfy corner (candles, blankets, fairy lights all encouraged!) where they felt safe and could relax, and then led them through a guided meditation-type prayer. It included questions or ideas to talk to God about, and helping them to hand over their anxieties and worries to Him.

After receiving positive feedback, and after a really helpful Nurturing Birth mentoring session with Michelle, who encouraged me to pursue this more, I decided to begin advertising a bit wider, to friends of friends and through local churches too. The sessions are now growing and it’s wonderful to be able to help people find some peace, quiet, and space to reflect in what can be both such a hopeful and also a scary time of pregnancy.

I now have a mailing list to keep everyone updated with the dates and Zoom codes, a discount offer to buy a journal from my friend’s stationery company, as well as other information about the services I am offering. This is such a valuable way to keep in touch with my ‘attendees’, and it’s wonderful to hear their baby news and how my sessions have helped. Just yesterday I got this message on Instagram:

‘Delighted to share that my daughter was born beautifully last week. The birth was calm, empowering and wonderful. She is doing really well, as are we.’

RETREATS

I have also started leading Zoom ‘Pregnancy Retreat’ mornings, which involve a smaller group coming together, sharing where they are at, praying for each other, having quiet space reflecting, some worship songs and a creative journaling session. I also show some video stories of women talking about their positive birth experiences in 2020, and how they ensured their faith was very much a part of their experience.

Although Covid has had such a negative impact on maternity services (and so many other things!) I find it is also worth noting the different opportunities that have opened up, for people to access things in new and different ways. Running a retreat on Zoom is certainly not something I would have thought of pre-2020, but a major benefit is that people can attend from the comfort of their own homes, without the need for travel logistics and expense. I have even had people attend the sessions from New Zealand and South Africa!

AND NOW…

Hosting the prayer sessions twice a month has given me an opportunity to put myself out there, introduce myself to women on their pregnancy journey, and become a potential, trusted person to support them further. I am so excited to have my first birth client booked in. I don’t think I will quite believe it, until I actually see that baby born, but I am so ready for my first ‘actual’ birth as a doula!

Although clearly my ‘niche’ is focused around my own Christian faith and those who I know in my church circles, I do hope and really believe that some of these ideas could benefit anyone (with faith or none) who is expecting a baby. The practice of *stopping* in our busy schedules, writing stuff down, thinking, reflecting and ‘letting go’ of worries and burdens is so beneficial. And in the age of mindfulness, self-care and developing healthy boundaries, I hope this is something that we as doulas can support, sign-post and encourage our clients in.

It’s amazing to see the array of online-accessible classes and meet-ups, which I am always keen to recommend to friends and clients, such as hypnobirthing, pregnancy journal sessions and much more. There is definitely something for everyone out there and we can see all these things as tools available to us and our clients. It’s amazing for women and their partners to access what they can to feel equipped, empowered and prepared not just for the birth, but for each step of their pregnancy and into parenthood too.

If anyone would like to find out more, or may like to collaborate in developing spaces or events online to benefit their clients in some way, please do get in touch with me, I would love to hear from you and see what other creative things we can explore.

Here is my Nurturing Birth Directory listing: https://nurturingbirthdirectory.com/doulas/united-kingdom/south-gloucestershire/bristol/helena-whitwell/

doula.helena@gmail.com    

Follow me on Instagram:  @doula_helena

Thanks for reading. I wish you all really well as we hop, skip and jump expectantly into the NEW Year!!